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Anne-Marie Logan @AnneMarieLogan2My practice is a bit specialised so certainly everyone has headache. Most have migraine and it is very rare that we see someone with tension type headache (TTH) #physiotalk

Tom Pointing @PointingPhysio@physiotalk We were taught this at Uni on Thursday mainly about cervicogenic headaches, we were taught to treat holistically throughout the biopsychosocial model but otherwise I wouldn’t know where to start for other types #physiotalk

Ian Tyrrell @IanTyrrell5@physiotalk I work in a niche area,I know how to deal with what I have to deal with in this area. This is from experience, couldn’t say I work on an evidence base, just do what has worked in the past for me. #physiotalk

Sarah Edwards @lloydandsarah25@physiotalk Not much as an undergraduate and only once discussion and treatment options discussed in our local In-Service Training in our locality in past few years....#physiotalk

Anne-Marie Logan @AnneMarieLogan2I think first of all that Physios should not feel that it is just our profession that struggles with headache. Nurses, doctors Pharmacists all find headache difficult and get little teaching. #physiotalk

Anne-Marie Logan @AnneMarieLogan2ID – migraine test
Question 1: You felt nauseated/sick?
Question 2: Light bothered you (a lot more than when you didn’t have a headache)?
Question 3: Your headache limited your ability to work, study, play ?
This one is on the National Migraine Centre website
#physiotalk

Anne-Marie Logan @AnneMarieLogan2There are many screening tests for migraine but the quickest is the ID migraine as before. It looks for the limited function, photophobia and nausea that are so common in migraine #physiotalk

physiotalk @physiotalkQ
Cervicogenic headache can often be confused with migraine - how can Physiotherapists differentiate between them? #physiotalk

physiotalk @physiotalkRT @AnneMarieLogan2: We were taught very little and yet are meant to be the specialists in CGH. I think in some places that is changing but…

Sarah Edwards @lloydandsarah25@physiotalk If cervical movements reproduce symptoms then it is likely the cause of their symptoms. Also if symptoms are unilateral it is indicative of cervicogenic headaches. #physiotalk

Anne-Marie Logan @AnneMarieLogan2@lloydandsarah25@physiotalk What is important about an MDT approach with CGH is that when you know you neurology department or local headache service, greater occipital nerve blocks can be a useful adjunct to allow therapy to help these patients. #physiotalk

Fiona Lucas @fi_firstchoiceHi Anne-Marie. I'm interested in the self management programmes you have mentioned for headaches, I work with a Neurologist in Bournemouth who is keen on our Department setting up a group. He has been inspired by the work carried out by CHESS at Warwick Uni? #physiotalk'

Anne-Marie Logan @AnneMarieLogan2@physiotalk I get asked to see headache patients in our physio department and the two reasons why the physios are struggling are either that the patient has chronic migraine or that they have medication overuse headache #physiotalk

Sarah Edwards @lloydandsarah25@physiotalk I have seen them but not identified until after a talk form a clinical psychologist that takes about medication overuse at a study day. We see so many people on so many medications and they don't know why or what for....#physiotalk

Anne-Marie Logan @AnneMarieLogan2@JoFallsPhysio@physiotalk The headache stops responding to simple painkillers over time and may fluctuate through the day with painkiller use. Patients often move up to opiates when paracetamol, ibuprofen etc stops working. The pain becomes near constant. #physiotalk

Anne-Marie Logan @AnneMarieLogan2@physiotalk As Ian will have experienced in ED, headaches can sometimes be worrying and really headache is a team game.
I feel that headache is not a first contact practitioner condition. We do not have the training or knowledge of the vast range of potential headache diagnoses #physiotalk

Anne-Marie Logan @AnneMarieLogan2@PT_sevda@physiotalk An excellent place to start. There are a lot of Neurologists who feel that TTH is actually part of a continuum with migraine but it is a seperate condition in the classification at the moment. #physiotalk

Jo Kitchen @J0Physio@physiotalk I don’t think it’s the best fit for first contact as there are so many diff Dx but for someone with neck pain and headaches I think it would be appropriate. I had pts self-refer with headaches as a band 5. #physiotalk

physiotalk @physiotalkWell everyone, that’s the hour up - thank you all for another most excellent #physiotalk!

Sarah Edwards @lloydandsarah25@physiotalk If there were neurological deficits alongside headaches such as limb weakness or visual loss (check cranial nerves) /effects-jaw claudication (temporal arteritis) and if there was signs of infection/sickness along with headache these would be my red flag worries..#physiotalk

Ian Tyrrell @IanTyrrell5@physiotalk I think any FCP needs to have a broader understanding on physical conditions rather than just msk! We as physios do “neuro assessments” but no way near a full cranial nerve examination, to rule out the serious with confidence need to be skilled in this #physiotalk

Anne-Marie Logan @AnneMarieLogan2@mariand84@physiotalk One of the reasons to discuss with the referrer.
Over the age of 50 new onset headaches have a higher risk of secondary pathology so you would be checking to see whether the patient really had never had any headaches in the past. #physiotalk

Anne-Marie Logan @AnneMarieLogan2@spiteri_anna@physiotalk Migraine is underdiagnosed and undertreated so the best thing we can do is recognise it and alert our GP / neurologist colleagues. It responds to graded exercise, regular lifestyles, managed anxiety and depression, no delays in meals and medication when needed. #physiotalk

Anne-Marie Logan @AnneMarieLogan2@hipsterlife85@JoFallsPhysio@physiotalk It can happen when painkillers are used for any condition. This is difficult when the patient has arthritis for instance as well as migraine. It needs careful management of the arthritis without frequent painkillers without provoking the chronic headache #physiotalk

Anna Spiteri @spiteri_anna@AnneMarieLogan2@physiotalk That is really interesting. Do you think it’s on the increase when our hectic lifestyles, lack of sleep and increased screen time. When I assess teenagers I often hear about screens on until well after midnight on a regular basis #physiotalk

Janet Thomas @JanetThomas47Following tonight's #physiotalk I feel a headache coming on😐
I know what I need though - A good night's sleep! It's been a busy few days...